An inclusive approach to Human Papilloma Virus vaccination: the case for gender neutral vaccination in Canada

Human papillomavirus (HPV) is the most common sexually-transmitted infection among Canadians (1). The causal link between specific serotypes of HPV and cervical cancer is well-established (2). HPV infections lead to more than 500,000 cases of cervical cancer worldwide each year (3), and have motivated a strong research campaign to develop rigorous screening tests and prophylactic HPV vaccines (2). Gardasil was first approved in 2007 as a quadrivalent vaccine to prevent HPV infection in young women (4). This vaccine has proven to be safe and effective, with significant reductions in genital warts and cervical lesions in vaccinated females (3). In 2007, Australia became the first country to implement An inclusive approach to Human Papilloma Virus vaccination: the case for gender neutral vaccination in Canada Sabrina Bartolucci, Lilia Brahimi, Allison Hecht, Jasmine Li-Brubacher, Natasha Leblanc, Geneviève Mailhot, Janna Shapiro, and Chelsey Weir 9 a national HPV vaccination program, administering Gardasil through a school-based program targeting females aged 12 and 13 years while implementing a catchup program for females aged 13 to 26 in a school or community setting (5, 6). In 2009, the World Health Organization (WHO) recommended the implementation of a national HPV vaccine program aimed at countries with high levels of HPV infection and cervical cancer (7). Since then, many other countries have followed Australia’s path and implemented similar programs.

In 2015, Prince Edward Island, Alberta, Nova Scotia, Quebec and Manitoba were the only provinces that had implemented a gender neutral vaccination program (1). Other provinces, such as British Columbia had implemented male vaccination for the men who have sex with men (MSM) population (1). As of 2017, all provinces and territories have adopted gender-neutral vaccination programs for pre-adolescents. The many benefits of a gender-neutral HPV vaccine, however, do not come without risks and costs. The objective of this case study is to assess all aspects of a gender-neutral approach to the HPV vaccine, and to demonstrate the impact of vaccination in both males and females on the improvement of overall HPV-related outcomes compared to female-only vaccination regimens. HPV-related outcomes assessed include health outcomes, cost effectiveness, and gender equality.